A woman has been 5 cm dilated for the past 3 hours.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

The fetal heart rate tracing demonstrates recurrent deep variable decelerations with a rapid drop in FHR, a V-shaped pattern, and slow return to baseline. These are classic signs of cord compression. According to NCC, AWHONN, Miller, Menihan, and Simpson, recurrent variable decelerations require immediate intrauterine resuscitative interventions before any decision regarding operative birth.

NCC-aligned intervention steps include:

Maternal repositioning (first-line for cord compression)

Reducing or stopping oxytocin if infusing

IV fluid bolus

Amnioinfusion (if appropriate and recurrent deep variables persist)

Oxygen only if other measures fail (per NCC/AWHONN updated guidance)

The cervix has remained unchanged at 5 cm for 3 hours (a prolonged latent or early active labor pattern), but the fetal tracing shows Category II—recurrent variable decelerations. Category II dictates corrective action, not immediate delivery unless it progresses to Category III.

Cesarean birth (option C) is reserved for:

Persistent Category III

Failure of intrauterine resuscitation

Proven fetal intoleranceNone of these conditions have been met yet.

Thus, the correct initial management is B. Perform intrauterine resuscitative measures.